The original file is kept in the office. This is the text saved from it.
1 page
100%
Male Others Female
01. Full Name:
Last / Surname
02. Permanent Address:
Contact No.: Email:
03. Address in Bangladesh:
DD / MM / YYYY
04. Date of Birth:
05. Sex:
06. Place of Birth: 07. Present Nationality:
08. Nationality at Birth: 09. Occupation:
10. Marital Status:
RICHARD NAVEA ROSERO
14 BANABA STREET, SOUTH SIGNAL VILLAGE, TAGUIG CITY, NATIONAL CAPITAL REGION 1636, THE PHILIPPINES
+63 908-1814-264 ricrose11@yahoo.com
ATATURK TOWER, FLAT# 11/A (LIFT # 10) 22 KEMAL ATATURK AVENUE, BANANI, Dhaka- 1213
01324433326
11/12/1978
LAGON O Y CAM SUR Philippine
Philippine PRIVATE SERVICE
PERSONAL DETAILS
TRAVEL DOCUMENT DETAILS
11. Passport No: 12. Type of Passport:
14. Date of Issue: 15. Date of Expiry:
16. Date of Last Visit to Bangladesh:
17. Last Visa No.: 18. Date of Issue:
P5187371A
29/11/2017 28/11/2022
08/12/2021
A2641813 16/01/2022
ORDINARY
Government of the People's Republic of Bangladesh
D.I.P Form-4(Free of cost)
Department of Immigration & Passports
Machine Readable Visa Application Form
First / Given Name(s)
Contact No.: Email:
ricrose11@yahoo.com
(as in the passport)
DD / MM / YYYY DD / MM / YYYY
DD / MM / YYYY
DD / MM / YYYY
AGARGAON * Name of Office / Bangladesh Mission:
* Please Go Through The General Instructions Before Filling Up The Visa Form.
* This Form Should Be Filled Up In Capital Letters. Put A Check [ √ ] In Appropriate Box.
Single Seperated Married Divorced Widowed
Engaged
Invalid Annulled Cohabitating Deceased Spouse's Death
Common Law None Others MARRIED
13. Place of Issue: DFA MANILA
Web Application
19. Place of Issue: 20. Date of Expiry:
AGARGAON
PAYMENT DETAILS
21. Name of the Bank and Branch:
22. Cheque/Bank Transfer/Chalan/Scroll No.:
23. Amount Deposited: 24. Date:
NEW VISA
,
DD / MM / YYYY
25. Purpose of Visit:
26. Duration of Proposed Stay in Bangladesh:
27. Tentative Date of Arrival in Bangladesh:
28. Intended Number of Entries:
DD / MM / YYYY
Business Dependent Diplomatic
Single Re-Entry Multiple
Employment Investment
Official Student Tourism Transit Others
(Please Specify)
30. Date of Arrival
37. Duration of Proposed Extension:
36. Purpose of Extension of Visa:
32. Type of Visa:
08/12/2021
31. Visa No:
A2641813
DD / MM / YYYY in Bangladesh:
E
33. Date of Issue:
EMPLOYMENT
AGARGAON
35. Place of Issue:
16/01/2022
DD / MM / YYYY
34. Date of Expiry:
28/03/2022
DD / MM / YYYY
3 Month(s)
29. Name of the Father/Mother/Spouse/Other(Relation):
EXTENSION OF VISA
NO VISA REQUIRED FOR TRAVEL TO BANGLADESH
39. Father's Name:
47. Type of Visa:
42. Date of Arrival in Bangladesh:
48. Reason For Proposed NVR:
40. Mother's Name:
41. Spouse Name:
Nationality:
Nationality:
Nationality:
DD / MM / YYYY
DD / MM / YYYY
43. Visa No:
44. Date of Issue:
DD / MM / YYYY
45. Date of Expiry:
46. Place of Issue:
38. Intended Number of Entries: Single Re-Entry Multiple
28/03/2022
DD / MM / YYYY
(Taka/US$)
CHECK LIST
Recommendation from concern Ministry Authority
Security Clearance / Security Certificate
Father's / Husband's / Mother's Visa copy
Passport Copy, Last Visa and Last Arrival Page
Father's / Husband's / Mother's Passport copy
N. O. C from Sri Lankan High Commission
Bi-Lateral Agreement / Multilateral Agreement
Trade license of the sponsoring Company
Payment Slip Over stay Payment Slip
Marriage Certificate
Birth Certificate
Work Permit
Affidavit
Photo
Income Tax Certificate of the Company
TIN
TIN Certificate of the Company
Others
I hereby declare that statements given above are true and will not request to refund my paid visa fee even if my Application is declined.
Place:
Date:
DD / MM / YYYY Signature
(RICHARD NAVEA ROSERO)
Bangladesh
20/03/2022
√
√
√
√
√
√
√
√
TRANSIT/ON ARRIVAL VISA
53. Travelled by(Vessel's/Flight/Vehicle Name & No):
51. Date of Arrival in Bangladesh:
55. Purpose of Visit to Bangladesh:
DD / MM / YYYY
52. Name of check post:
56. Duration of Proposed Stay:
54. From:
49. Amount of Investment (For Investor):
50. Name and Address of Company:
Incorrect Correct
POLICE VERIFICATION
Memo No Date
DD / MM / YYYY
Information's are found
If not correct: Reasons:
Signature and Seal of Inquiry Officer Signature and Seal of Issuing Officer
FOR OFFICIAL USE
Reference No: Date: Amount of Fee:
Visa No: Date: Date Expiry:
Number of Entries Extension Re-Entry Multiple Entries NVR
Date:
Recipient's Signature
Date & Seal
Authorized Signature
OA0000002836215